# KANCC MEDICAL PLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Kancc Medical
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437710563
- **Authorized official:** PETER R NWOKE M.D (OWNER)
- **Authorized official phone:** (313) 473-8525

## Contact information

- **Practice address:** 17331 MACK AVE, DETROIT, MI 48224-2250
- **Practice address phone:** (313) 473-8525
- **Practice address fax:** (313) 473-8521
- **Mailing address:** PO BOX 806464, SAINT CLAIR SHORES, MI 48080-6464
- **Mailing address phone:** (313) 473-8525
- **Mailing address fax:** (313) 473-8521

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |
| 261QP2300X | Primary Care Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 06/28/2019
- **Last updated:** 07/18/2022